Microembolic signal monitoring of TOAST-classified cerebral infarction patients

Abstract

The aim of the present study was to investigate the effects of microembolic signals (MES) on post-stroke neurological deficits, stroke recurrence and survival in patients with acute cerebral infarction (CI). Patients with acute CI were enrolled consecutively and classified etiologically into the following 4 subtypes using the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification: i) Cardioembolism (CE); ii) large-artery atherosclerosis (LA); iii) small-vessel disease (SVD); and iv) stroke of other etiology, including other and undetermined etiologies. The MES of cerebral arteries were monitored by transcranial doppler (TCD), carotid atherosclerotic lesions were detected by color Doppler sonography and extracranial and intracranial magnetic resonance angiography were performed. Next, the severity of neurological deficits was evaluated using National Institutes of Health Stroke Scale (NIHSS) scores. Cases of stroke recurrence and post-stroke mortality were recorded. A total of 135 patients were recruited, including 33 with CE, 49 with LA, 24 with SVD and 29 with stroke of other etiology. A significant difference in the incidence of MES was identified between the 4 subtypes (P=0.025). The occurrence of positive MES was found to markedly correlate with a history of coronary heart disease (P<0.001) and antithrombotic treatment (P=0.045) and increased levels low density lipoprotein (P=0.036). Compared with patients with negative MES, no significant changes in NIHSS scores were found in patients with positive MES on days 1 and 7 following admission. The incidence of recurrent stoke and post-stroke mortality was elevated 3 months from the onset of CI. In conclusion, a significant difference in the occurrence of MES was identified between subtypes of patients with acute CI. The incidence of recurrent stroke and mortality was increased among patients with positive MES 3 months from onset.